Objective: To present and compare two multi-criteria decision techniques (analytic
hierarchy process [AHP] and conjoint analysis [CA]) for eliciting preferences
in patients with cervical spinal cord injury (SCI) who are eligible for
surgical augmentation of hand function, either with or without implantation
of a neuroprosthesis. The methods were compared in respect to attribute
weights, overall preference, and practical experiences.
Methods: Two previously designed and administered multi-criteria decision
surveys in patients with SCI were compared and further analysed. Attributes
and their weights in the AHP experiment were determined by an expert panel,
followed by determination of the weights in the patient group. Attributes for
the CA were selected and validated using an expert panel, piloted in six patients
with SCI and subsequently administered to the same group of patients
as participated in the AHP experiment.
Results: Both experiments showed the importance of non-outcome-related
factors such as inpatient stay and number of surgical procedures. In particular,
patients were less concerned with clinical outcomes in actual decision
making. Overall preference in both the AHP and CA was in favor of tendon
reconstruction (0.6 vs 0.4 for neuroprosthetic implantation). Both methods
were easy to apply, but AHP was less easily explained and understood.
Conclusions: Both the AHP and CA methods produced similar outcomes,
which may have been caused by the obvious preferences of patients. CA may
be preferred because of the holistic approach of considering all treatment
attributes simultaneously and, hence, its power in simulating real market
decisions. On the other hand, the AHP method is preferred as a hands-on,
easy-to-implement task with immediate feedback to the respondent. This
flexibility allows AHP to be used in shared decision making. However, the way the technique is composed results in many inconsistencies. Patients preferred
CA but complained about the number of choice tasks.